Effects Of Da Huang Jian Ji On Serum Inflammatory Factors And Cognitive Functions In Patients With Hepatic Encephalopathy With Damp-heat Syndrome

Objective: Based on the curative efficacy and safety of Da Huang Jian Ji in the treatment of Hepatic Encephalopathy(HE),the aim of this study was to observe the effects of Da Huang Jian Ji on serum inflammatory factors(TNF-α IL-6)and cognitive function(MMSE HDS-R score)in patients with hepatic encephalopathy(HE)with damp-heat syndrome during decompensation of hepatitis B cirrhosis,and explore the partial mechanism of Da Huang Jian Ji in the treatment of HE,to provide clinical evidences for the prevention and treatment of hepatic encephalopathy with traditional Chinese medicine.Methods: A randomized controlled trial design method was used to study 64 inpatients from the Department of Hepatology of the First Affiliated Hospital of Guangxi University of Chinese Medicine.Sixty-four patients who met the inclusion criteria for hepatic encephalopathy with damp-heat syndrome in decompensated stage of hepatitis B cirrhosis were coded according to the sequence of hospitalization.according to the Stata SE15 software produced by random number table randomly assigned into the treatment group(rhubarb decoction group)and control group(lactulose group),32 cases in treatment group,control group 32 cases.Patients in both groups were treated with retention enema on the basis of comprehensive Western medicine treatment.Patients in the treatment group were treated with Da Huang Jian Ji(rhubarb 30 g,black plum 30g)retention enema.The control group received lactulose retention enema.The course of treatment was 7 days.HE grading,liver function(TBIL,ALT,ALB),serum ammonia,serum inflammatory factors(TNF-α,IL-6)levels,TCM syndrome scores,cognitive function(MMSE,HDS-R scores)and other related indexes in 2 groups were compared and analyzed before and after treatment.Results:(1)In this study,64 patients were included,including 32 patients in the control group and 32 patients in the treatment group.Among them,1 patient in the control group was excluded(because the patient could not cooperate with the treatment),and 1 patient fell out(automatic discharge).In the treatment group,2 cases fell out(automatic discharge),and due to incomplete data,the cases were excluded,so they were not included in the statistical analysis of the final trial data.A total of 60 cases were finally completed and included in the statistical analysis of the trial data.(2)Comparison of differences in basic data: There was no statistical significance in gender,age,HE grade and other basic data between the treatment group and the control group(P > 0.05),indicating balanced comparability.(3)Comparison of HE grading and comprehensive efficacy: After treatment,the HE grades of patients in the two groups improved to different degrees,and the improvement of HE grades in the control group and the treatment group was compared(P < 0.05),the difference was statistically significant.The improvement of HE in treatment group was better than that in control group.After treatment,the total effective rate of the control group was 80%,and the total effective rate of the treatment group was 90%.Comparing the comprehensive efficacy of the two groups,P < 0.05,the difference was statistically significant.The curative effect of the treatment group was obviously better than that of the control group.(4)Comparison of the awakening time of HE patients: The time required to wake up in the treatment group was significantly shorter than that in the control group,and the difference was statistically significant(P < 0.05).(5)Comparison of liver function(TBIL,ALT,ALB)and plasma ammonia: After treatment,plasma ammonia in 2 groups decreased,while TBIL and ALT were improved(P < 0.05).After treatment,compared with the control group,the decrease of serum ammonia level in the treatment group was greater,and the improvement of TBIL and ALT was more obvious,with statistical significance(P < 0.05).The comparison of ALB in the two groups before and after treatment and the comparison of ALB in the two groups after treatment showed no statistical significance(P > 0.05).(6)Comparison of TCM syndrome scores: After treatment,TCM syndrome scores of HE patients in both groups were lower than those before treatment,P < 0.05,the difference was statistically significant.After treatment,the reduction of TCM syndrome scores in treatment group was more obvious than that in control group(P < 0.05).(7)Comparison of curative effect of TCM syndrome improvement: The total effective rate of TCM syndrome improvement in the control group was 80%,and that in the treatment group was 93%.The comparison of the efficacy of TCM syndrome improvement in the two groups was statistically significant(P < 0.05).The total effective rate of TCM syndrome improvement in the treatment group was significantly higher than that in the control group.(8)Comparison of serum inflammatory factors(TNF-α,IL-6): Serum TNF-α and IL-6 in 2 groups decreased after treatment,and the difference was statistically significant compared with before treatment(P < 0.05).The decrease of serum TNF-α and IL-6 in treatment group was more obvious,and the difference was statistically significant(P < 0.05).(9)Comparison of cognitive function(MMSE,HDS-R score): MMSE and HDS-R scores in 2 groups were higher than those before treatment,P < 0.05,and the difference was statistically significant.The MMSE and HDS-R scores in the treatment group were significantly better than those in the control group.Conclusions:(1)Da Huang Jian Ji retention enema has a definite effect on hepatic encephalopathy.(2)The effect of rhubarb decoction retention enema in the treatment of hepatic encephalopathy was better than that of lactilose retention enema,which may be related to the effect of reducing serum pro-inflammatory cytokines(TNF-α,IL-6)after colonic mucosa absorption.